This blog explores my professional experiences and personal feelings as I have worked with people who are in the last chapter of their lives. I dedicate this blog to all of these people who have each taught me something new about life and about myself. The stories in this blog, however, are all fictionalized. Any resemblance to real life people and circumstances is purely coincidence.

Saturday, June 26, 2004

When people are asked, how do you want to die? You rarely hear an answer of plane crashes, car accidents, heart attacks, drowning, or cancer. The most frequent response I have heard is "I want to die peacefully in my sleep." This response, however, has come from people who are relatively healthy.

I've recently had two patients who are terminally ill whom have an intensely real fear of dying in their sleep. One patient, each time she enters the hypnopompic state - the transitional state of semiconsciousness between sleeping and waking - she goes into a panic attack. "Help me! Help me! I can't breathe!" She is speaking, therefore she is breathing. However, she has the sensation that she cannot breathe. She is terrified that she will die in her sleep.

A second patient, who is also terminally ill, will not allow her bed to be flattened out completely. "I'm afraid I will die if my bed is flat." Some patients breathe more easily when the head of their bed is elevated, however, this particular patient has no difficulty breathing. She readily admits she has developed an association between sleeping while lying flat and death.

This wish for a peaceful, unconscious end to life for some comes from a desire to leave this world without having contemplated their own death. "Take me away before I even register what is happening." For others, this fear of dying while sleeping peacefully is an indication of a lack of preparation or readiness for death.

Tuesday, June 22, 2004

His mother was at the hospital and he knew she would likely die tonight. He'd called the nurse at 10pm before going to bed and had been told that his mother was "still hanging in there." He'd told the nurse he would check back at 7am and then he turned his phone ringer off so he could try to get some sleep. But something woke him up at 2am and he called again.

"I'm sorry, Mr. Jarrard. Your mother died a few hours ago. We tried to reach you by phone to tell you, but no one answered. I'm so sorry for your loss."

He had been dumbstruck. Though he'd called at least a half-dozen times now, each time expecting to hear this response, he hadn't been prepared when the words were finally spoken. He hadn't planned how he would respond. He suddenly felt lost and uncertain.

The nurse continued, "A few minutes before she died, I told your mother, 'Your son must care about you very much. He's called here every hour to check in on you.' She died less than an hour later. So she died knowing that you love her."

He was perplexed. Had his mother been awake? She had been in a coma for days at home. Had he missed seeing her awake and alert one last time?

"Was she sleeping?" He needed to know.

"Oh, yes, but we always assume that people can hear. So I spoke to her anyway," the nurse explained.

"What do you think caused her death?" He knew that she had been dying of cancer for months now. But suddenly, he thought that he had killed her. His mother had desperately wanted to die at home. He had washed and bathed her and changed her diapers for weeks. Then the last two days, she had begun to moan as if she was in pain and he had been terrified, not knowing what to do. He had brought her to the hospital that afternoon. He asked directly, "Do you think she died of a broken heart?"

"Oh, no. Her liver finally gave out and she simply stopped breathing," the nurse explained.

Though the nurse offered, he insisted that he didn't want to see her dead body. Even the thought of seeing his mother dead terrified him. A small voice in the back of his head admitted that was truly why he brought her into the hospital. He couldn't imagine being at home and having her die there alone with him. He waivered between feeling relief and guilt that he had let her die in the hospital.

He rushed into the hospital. He didn't want to stay at home alone tonight. He had no family nor friends to turn to at two o'clock in the morning. So he raced toward the source of this kind nurse's voice on the phone.

Once he arrived on the hospital unit, he instinctively made a bee-line for his mother's hospital room. The nurse had explained that they had already sent his mother's body to the morgue. But he had to see the empty bed for himself.

The bed linens were still crumpled in place where she had lain. The lights were on brightly. But the room was barren of life.

A nurse rushed down the hallway towards him. "Hi, Mr. Jarrard." He recognized the voice immediately and reached out to take her extended hand. The nurse placed her other hand on his shoulder and began directing him toward a room across the hall. "Why don't we have a seat in here and chat for a bit?" He had told the nurse that he wanted to come in. She'd tried to encourage him to stay at home until sunrise, but she obviously didn't understand how lonely he felt. The world suddenly felt cold without the warm presence of his mother.

The nurse asked politely if any family lived nearby. Mr. Jarrard shared his plans for his mother's funeral. The nurse then sent in the doctor and a chaplain to answer any questions. Despite the number of people stepping up to offer their condolances and support, he realized that no one could take away his loneliness.

After about an hour, realizing the sunrise was just a short while away, Mr. Jarrard finally felt ready to face his cold empty home again. Despite the months of preparation for this day, his whole life had changed and he was suddenly left floating aimlessly in the shock of his grief. He had never felt so alone before in his entire life.